Determination of Risk Factors for Surgical Complications in the Pediatric Population: Analysis of 98 Peri-operative Parameters
Aaron C. Weinberg, BS, Bradford Tinloy, BS, Mordechai D. Raskas, BA, Frank J. Penna, MD, Lin Huang, PhD, Drew A. Freilich, MD, Alan B. Retik, MD, Hiep T. Nguyen, MD.
Children's Hospital Boston, Boston, MA, USA.
BACKGROUND: There is a paucity of literature detailing specific peri-operative parameters and comorbidities that correlate with surgical complications in the pediatric population. Determination of particular parameters would be beneficial in stratifying risk with the goal of preventing potential complications. This would result in better surgical outcomes, decreased patient morbidity and mortality, and minimized health care costs through improved surgical decision-making.
METHODS: A retrospective review was conducted on 142 children from 1 day to 18 years of age undergoing all types of surgery at our institution with a perioperative complication as documented in the CRICO and Children’s Hospital database (Case Coordination, Clinical Peer Review, Occurrence and Mortality database). Ninety-eight parameters were reviewed in the patients who had a complication and 82 parameters were reviewed in the control population of 721 children. There was no exclusion criteria based on diagnosis. Univariate and multivariate statistical analyses were conducted using a stepwise method for model selection.
RESULTS: The majority of the complications was cardiovascular (38.4%), pulmonary (14.3%), and neurologic (14.8%) and were recognized within the first postoperative day (46.7%). Most complications (63.1%) were classified as Clavien Grade 3B, requiring an intervention under general anesthesia. There was no seasonal distribution of complications. In the univariate analysis, thirty-three parameters were found to be statistically significant. Multivariate analysis is listed in Table 1.
Table 1. Multivariate Analysis of Risk Factors for Surgical Complications
|Risk factors:||Odds Ratio||95% Confidence Interval|
|Gestational Age: Full Term||0.116||0.039||0.340|
|2 or more medications||53.088||9.717||290.030|
|Cardiovascular surgery performed||4.060||1.278||12.900|
|Neurological surgery performed||17.213||5.524||53.635|
|Heart rate (<2 or 98 percentile for age)||2.980||1.233||7.202|
|PO2 < = 96%||5.870||1.936||17.795|
CONCLUSIONS: Several risk factors were associated with surgical complications in the pediatric population. These parameters suggest a potential risk to the patient and should be considered during evaluation for surgical intervention. The risk-benefit analysis involved in surgical decision-making is complex, yet is invariably linked with patient safety.